World Rabies Day: Awareness Is the Best Defence Against Rabies

WORLD RABIES DAY: AWARENESS IS THE BEST DEFENCE AGAINST RABIES

Whilst discussing pet passports with your clients, are you telling them about the implications of them or their children contracting rabies from stray dogs they befriend on their holidays? How about with the practice nurse planning to volunteer at a neutering clinic in Eastern Europe? Your son or daughter off jungle trekking? Whilst we are used to discussing the risks of rabies to pets, most vets probably know much less about the risks of rabies to humans. World Rabies Day on 28 September, coordinated by the Global Alliance for Rabies Control, is an ideal time to promote understanding of this devastating but preventable disease in your practice.

150 deaths a day Every day 150 people die of rabies, of which more than 100 are children. This equates to one death every ten minutes and even this is likely to be a huge underestimate. Children are especially susceptible as they are more likely to have close contact with dogs at face level.

The common perception that a deep bite is necessary for contraction of the disease is incorrect: a lick on broken skin or mucous membranes or a scratch from an infected animal is sufficient. If wound cleansing and post exposure immunisations are not provided, because of the variable and often prolonged duration of the incubation period there is then an uncertain wait several months to see if the victim shows signs of rabies. Once clinical signs develop, the disease is almost invariably fatal: only one girl is ever known to have survived acute, unvaccinated rabies.

First symptoms The first symptoms of rabies are flu-like, including fever, headache and fatigue, then progress to involve the respiratory, gastrointestinal and/or central nervous systems. In the critical stage, signs of hyperactivity (furious rabies) or paralysis (dumb rabies) dominate. Both forms eventually progress to complete paralysis, followed by coma and death in all cases, usually due to respiratory failure. Without intensive care, death occurs during the first seven days of illness.

Dogs Dogs continue to act as the main reservoir for rabies in the Middle East, Africa and Asia and are responsible for the majority of human rabies deaths worldwide. Bat rabies however is emerging as an increasing public health problem in the Americas.

Simple advice Simple advice may well save lives. You do not need to be engaged in any particular activity to be exposed to rabies as rabid animals will bite unprovoked and can show up almost anywhere. Clients should be advised that contact with wild or domestic animals during travel should be avoided. They should not attempt to pick up an unusually tame, unfamiliar animal and should not attract stray animals by being careless with litter. Pre- exposure vaccination should be considered for those travellers at particular risk (those who will not have access to medical facilities where they can receive a good quality human vaccine, and preferably immunoglobulin, within 24 hours if bitten) and should be mandatory for all vets and nurses who are planning to work with animals in an affected country. Clients should be advised to seek medical advice as to whether a rabies vaccine is recommended for them prior to travel. All travellers should be aware that receiving a rabies vaccine prior to travel does not preclude the need for wound cleansing, medical evaluation and additional doses of rabies vaccine post exposure.

Wound cleansing Wound cleansing (15 minutes with soap and water, preferably in running water, followed by application of antiseptic) is probably the most important single thing along with post exposure immunisations, carried out as soon as possible after contact with a suspect animal.

WHO recommendations The World Health Organization (WHO) provides detailed advice and recommendations on rabies prevention. Following these recommendations can prevent the development of the disease in virtually 100% of exposures.

Think about it……

For more information, see: The Global Alliance for Rabies Control: www.rabiescontrol.net The World Health Organization: www.who.int/topics/rabies/en/ World Rabies Day: www.worldrabiesday.org/ World Rabies Day YouTube: http://www.youtube.com/user/worldrabiesday Blueprint for Rabies Prevention and Control: http://www.rabiesblueprint.com/ Health Protection Agency: http://www.hpa.org.uk/infections/topics_az/rabies/menu.htm